title: Body adiposity and type 2 diabetes: increased risk with a high body fat percentage even having a normal BMI.
abstract: Obesity is the major risk factor for the development of prediabetes and type 2 diabetes. BMI is widely used as a surrogate measure of obesity, but underestimates the prevalence of obesity, defined as an excess of body fat. We assessed the presence of impaired glucose tolerance or impaired fasting glucose (both considered together as prediabetes) or type 2 diabetes in relation to the criteria used for the diagnosis of obesity using BMI as compared to body fat percentage (BF%). We performed a cross-sectional study including 4,828 (587 lean, 1,320 overweight, and 2,921 obese classified according to BMI) white subjects (66% females), aged 18-80 years. BMI, BF% determined by air-displacement plethysmography (ADP) and conventional blood markers of glucose metabolism and lipid profile were measured. We found a higher than expected number of subjects with prediabetes or type 2 diabetes in the obese category according to BF% when the sample was globally analyzed (P < 0.0001) and in the lean BMI-classified subjects (P < 0.0001), but not in the overweight or obese-classified individuals. Importantly, BF% was significantly higher in lean (by BMI) women with prediabetes or type 2 diabetes as compared to those with normoglycemia (NG) (35.5 ± 7.0 vs. 30.3 ± 7.7%, P < 0.0001), whereas no differences were observed for BMI. Similarly, increased BF% was found in lean BMI-classified men with prediabetes or type 2 diabetes (25.2 ± 9.0 vs. 19.9 ± 8.0%, P = 0.008), exhibiting no differences in BMI or waist circumference. In conclusion, assessing BF% may help to diagnose disturbed glucose tolerance beyond information provided by BMI and waist circumference in particular in male subjects with BMI <25 kg/m(2) and over the age of 40.
authors.affiliation: Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gómez-Ambrosi
authors.forename: Camilo
authors.initials: C
authors.lastname: Silva
authors.forename: Juan C
authors.initials: JC
authors.lastname: Galofré
authors.forename: Javier
authors.initials: J
authors.lastname: Escalada
authors.forename: Silvia
authors.initials: S
authors.lastname: Santos
authors.forename: María J
authors.initials: MJ
authors.lastname: Gil
authors.forename: Victor
authors.initials: V
authors.lastname: Valentí
authors.forename: Fernando
authors.initials: F
authors.lastname: Rotellar
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ramírez
authors.forename: Javier
authors.initials: J
authors.lastname: Salvador
authors.forename: Gema
authors.initials: G
authors.lastname: Frühbeck
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D018149:Glucose Intolerance / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D050177:Overweight / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D010993:Plethysmography, Whole Body; D011236:Prediabetic State / Q000209:etiology; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055105:Waist Circumference; D055815:Young Adult